FAILURE TO THRIVE

What Is Meant By Failure To Thrive? Failure to thrive (FTT) means that, for whatever reason, a child does not gain the height and weight that is expected. The expectations of how well a child is growing must be realistic. They must consider the genetic, physical, psychological and social factors that influence a child's development. A child is considered failing to thrive when his/her weight is consistently less than the weight of the majority of children of its age (below the third percentile), if his/her weight is less than eighty percent of the ideal weight for their height and age, or if his/her rate of growth levels off unexpectedly.

What Causes Failure To Thrive? The causes of FTT can be divided into two categories, organic and non-organic. The organic causes of FTT are causes related to any acute or chronic physical illness the child may have that would prevent it from taking in enough nutrition. Some examples of organic causes include an inability to swallow food adequately, as in the case of a cleft lip or palate, or gastroesophageal reflux. A child may suffer from malabsorption, as in the case of celiac disease, cystic fibrosis, and lactase deficiency. There are also conditions such as diabetes mellitus where the body excretes valuable nutrients (e.g. glucose in the urine), losing them as a source of nutrition. Finally, there are certain chronic illnesses that increase the body's requirement for energy. These include cystic fibrosis and hyperthyroidism. Although these are some of the major organic causes of FTT, it is by no means a comprehensive list. Non-organic causes refer more to an interaction between the child and his/her primary caregiver or its environment, which prevents the child from growing to its full potential. In this case, the child does not have an underlying physical disorder; instead, there is a lack of food intake. This can be due to poverty, poor understanding of feeding techniques, improperly prepared formula (i.e. over-dilution), or an inadequate supply of breast milk (especially if the mother is stressed, exhausted or under nourished). In some instances, child abuse and/or neglect can contribute to FTT. It is important to realize, however, that poor caregiving does not always fully explain FTT. The child's temperament also helps determine the relationship between the parent and the child. Non-organic FTT can result from a spectrum of interactions ranging from a severely disturbed or ill child whose care is challenging even for the most able parent, to a co-operative and content child who is cared for by a mentally ill parent lacking any means of social or financial support. Although there is no rationale for child abuse or neglect, sensitivity to life stressors within a family must be considered when organic causes of FTT are ruled out. Statistically, it has been reported that 50% of cases of FTT are mainly caused by organic conditions, while the other 50% are mainly non-organic. However, non-organic and organic FTT can occur at the same time.

What Are The Signs And Symptoms Of FTT? Children who are failing to thrive commonly fail to reach the expected height, weight and head circumference for normal children of their age. However, there are other signs of poor nutrition, which include hair loss, muscle weakness, changes in skin pigmentation, skin infections, recurrent infections, fatigue, and apathy. If a child is undernourished he/she may also have a delay in developing physical skills such as rolling over, sitting, standing, and walking. Mental skills and social skills may also be delayed. If you have any concerns about your child's growth and development, contact your pediatrician as soon as possible.

With What Can FTT Be Confused? Failure to thrive can be confused with familial short stature. This means that a child is smaller than expected for its age because its parents and grandparents were short, but not because of poor nutrition.

What Can You Do For A Child Who Is Failing To Thrive? If you suspect that your child is failing to thrive, consult your pediatrician immediately. The care will usually consist of ensuring that the child is receiving enough nutrition (usually 150% of daily requirements) and to provide medical and social support depending on the cause of FTT. It will be important to rule out any organic causes of FTT and determine how the family is coping at home. For children with organic or mixed FTT, the underlying disorder should be identified and treated as soon as possible. For children with apparent non-organic FTT or mixed FTT, a multi-disciplinary team will be required to provide educational and emotional support to address problems which might be interfering with the parent-child relationship.

What Is The Usual Outcome Of FTT? It is important to identify FTT as soon as possible in order to prevent the serious complications of FTT which can affect all systems of the body and can be fatal if not treated. If FTT is detected early and the cause is determined and corrected, most children will experience normal growth and development. However, if the FTT is prolonged or if FTT occurs in the first year of life, a child may be developmentally delayed with possible cognitive problems.